Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness that primarily affects infants and young children. It is caused by several different types of enteroviruses, most commonly, Enterovirus 71 (EV71) and Coxsackievirus A16 (CA16). This condition is characterized by fever, sore throat, and blister-like lesions on the hands, feet, and mouth.
HFMD was first recognized in New Zealand in 1957. However, it likely existed prior to that but was not formally identified. Initially, it was believed to be solely caused by Coxsackievirus A16. However, with the development of advanced laboratory techniques and improved diagnostic methods, other enteroviruses like EV71 were also identified as causative agents of HFMD.
HFMD is prevalent globally and is endemic in many parts of the world. However, it is more commonly reported in the Asia-Pacific region, including countries such as China, Japan, Singapore, Malaysia, and Taiwan. Outbreaks are more prevalent during the warmer months and tend to occur in cyclical patterns every few years. While the disease is also found in other regions, such as Europe, North America, and Africa, its incidence is lower.
Transmission of HFMD usually occurs through direct contact with nose and throat discharges, saliva, fluid from blisters, and feces of infected individuals. The virus can also spread through respiratory droplets, such as through coughing or sneezing. It can survive on surfaces outside the body for several hours, increasing the risk of transmission via contaminated objects or surfaces.
Although HFMD affects people of all ages, children under the age of five are most susceptible due to their developing immune systems and lack of previous exposure. In densely populated areas such as daycares, schools, and boarding facilities, there is an increased risk of transmission. Additionally, the virus can be transmitted from mother to baby during childbirth.
The major risk factors associated with HFMD transmission include poor personal hygiene practices, close contact with infected individuals, and crowded living conditions. Lack of proper handwashing, sharing of contaminated objects, and failure to cover the mouth and nose when coughing or sneezing contribute to the spread of the virus.
The impact of HFMD varies across different regions and populations. In the Asia-Pacific region, particularly in countries like China and Taiwan, large-scale outbreaks occur periodically, affecting thousands of children. The disease can lead to severe complications in some cases, including viral meningitis, encephalitis, myocarditis, and acute flaccid paralysis.
Prevalence rates and affected demographics can differ within regions and even within countries. For example, in China, HFMD cases are more prevalent in rural areas compared to urban regions. This disparity may be due to differences in healthcare access, sanitation, and population density. Certain demographics, such as young children in crowded environments, are at a higher risk of infection and severe complications.
In conclusion, HFMD is a globally prevalent viral illness primarily affecting children. The disease is transmitted through direct contact with infected fluids and feces, as well as respiratory droplets. Risk factors include poor personal hygiene, crowded living conditions, and close contact with infected individuals. HFMD has a significant impact on different regions and populations, with variations in prevalence rates and affected demographics. Efforts to prevent and control the disease focus on maintaining good hygiene practices, early detection, and appropriate medical care.

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Seasonal Patterns: The data indicate a distinct seasonal pattern for Hand, Foot, and Mouth Disease (HFMD) in mainland China. The number of cases tends to peak during the summer months, specifically in June and July, surpassing the occurrence in other months. Additionally, there is a secondary peak in cases during the spring, particularly in April and May. In contrast, the winter months, ranging from November to February, generally exhibit the lowest number of cases.
Peak and Trough Periods: The highest number of HFMD cases in mainland China occur in June and July, identifying these months as the peak season for the disease. Conversely, the trough periods, when the occurrence of cases is lowest, are observed from November to February, indicating the lowest incidence of HFMD cases.
Overall Trends: Examination of the overall trends shows a steady increase in HFMD cases in mainland China over the years. From 2010 to 2023, there is a continuous rise in the number of reported cases, with some fluctuations from year to year. It is important to emphasize that the data only encompasses cases and deaths prior to July 2023. Furthermore, it is notable that the number of deaths caused by HFMD is generally low in comparison to the number of cases.
Discussion: The seasonal patterns of HFMD in mainland China suggest a higher prevalence of the disease during the summer months, particularly in June and July, which can be attributed to various factors such as warmer weather, increased outdoor activities, and a higher likelihood of transmission in crowded settings like schools and nurseries. The secondary peak in cases during the spring months may also be influenced by similar factors.
The overall upward trend in HFMD cases emphasizes the need for continuous surveillance and prevention efforts. Implementation and promotion of preventive measures, including good personal hygiene, proper handwashing practices, and sanitization of high-contact surfaces, are vital in reducing the transmission of HFMD. Moreover, targeted vaccination campaigns and public health educational programs could aid in controlling the spread of the disease.
It is important to acknowledge that the analysis solely relies on the provided monthly data for HFMD cases and deaths in mainland China. Further analysis is necessary to consider other factors such as population density, age distribution, and public health interventions in order to gain a comprehensive understanding of HFMD trends and develop effective strategies for prevention and control.